Published online Jul 26, 2021. doi: 10.12998/wjcc.v9.i21.5794
Peer-review started: March 12, 2021
First decision: April 13, 2021
Revised: April 24, 2021
Accepted: May 26, 2021
Article in press: May 26, 2021
Published online: July 26, 2021
With changes in lifestyle and diet worldwide, the prevalence of hyperlipidemic acute pancreatitis (HLAP) has greatly increased, and it has become the most common cause of acute pancreatitis not due to gallstones or alcohol. There are many available therapies for HLAP, including oral lipid-lowering agents, intravenous insulin, heparin, and therapeutic plasmapheresis (TPE). It is believed that the risk and severity of HLAP increase with rising levels of serum triglycerides (TG), thus a rapid decrease in serum TG level is the key to the successful management of HLAP. TPE has emerged as an effective modality in rapidly reducing serum TG levels. However, due to its cost and accessibility, TPE remains poorly evaluated until now. Some studies revealed its efficacy in helping to treat and prevent the recurrence, while some studies suggested that TG levels were not correlated with disease severity, mortality, or length of hospital stay. Thus TPE might have no beneficial effect for the outcome. This article gives an overview of the published evidence of TPE in the treatment of HLAP and outlines current evidence regarding individual outcome predictors, adverse effects of the procedure, and TPE in special occasions such as for pregnant patients and patients with diabetic ketoacidosis. Future direction of TPE research for HLAP is also discussed in this review.
Core Tip: Prevalence of hyperlipidemic acute pancreatitis has greatly increased and has become the most common cause of acute pancreatitis not due to gallstones or alcohol. Although therapeutic plasmapheresis has emerged as an effective modality in rapidly reducing serum triglyceride levels and has been used for hyperlipidemic acute pancreatitis clinically, the exact role of therapeutic plasmapheresis in the disease course is unclear and remains poorly evaluated. We herein outline the current evidence and discuss the future research directions.